Arch structure of trabeculae of the upper femoral end and its biomechanical significance in hip fractures.

We studied ultrastructurally the cancellous bone tissues of the upper femoral ends, collected from 12 patients undergoing endoprosthesis replacement for fractures of the femoral neck and from 7 fresh cadavers. The bone tissues were composed of meshwork of trabeculae, that constituted tier upon tier of anisotropic arch structures of different diameters and sizes. The arch structures of the cancellous bone tissues in the femoral heads assumed round or roundish configurations, whereas those of the femoral head-neck junctions revealed oval outlines and those of the femoral necks showed narrow oval profiles. The fine structures of the trabeculae in the femoral head could be divided into superficial zone, central zone, and transitional zone. Under weight-bearing, the central zone suited to sustain the load, while the superficial zone could produce elastic deformation lest fracture of the trabecaulae should ensue. The long axes of the oval arch structures of the femoral head-neck junction and the narrow oval arch structures of the femoral neck coincided with those of the femoral neck, thereby facilitating weight-bearing under physiological conditions. However, external violence in the form of either adduction or abduction force would act in a horizontal direction on the long axes of the oval and narrow oval arches so as to produce subcapital or transverse fracture of the femur in the aged.